BMCH2017-0092,�iG��G�/ �.�i Qu&Z
78-495 CALLE TAMPICO Twit D
IA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING. PERMIT
Application Number: BMCH2O17-0092
Property Address: 48243 CALLE FLORISTAS �.
APN: 646092022
Application Description: GONZALES /HVAC CHANGE OUT IFA
r� r ZQ��
Property Zoning:
Application Valuation: $8,000.00 ITYO �LA(]U1NTA
Y OE'JELCPP;"ch170ci?AT'.iE11T
Applicant:
IE INC
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C20 License No.: 763937
Date: a% 7 Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractors) licensed pursuant to
the Contractors' State License Law.).
I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's Address
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/27/2017
Owner:
JOHN KOSINSKI
48243 CALLE FLORISTAS
LA QUINTA, CA 52253
Contractor:
VOTTA ENTERPRISES INC DBA COMFORT AIR
72248 NORTHSHORE ST STE 101
THOUSAND PALMS, CA 92276
(760)320-5800
Llc. No.: 763937
WORKER'S COMPENSA-ION DECLARATION
I hereby.affirm under penalty of perjury one cf the following declarations:
I have and will maintain a certificaoe of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
�a I have and will maintain workers' ompensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: INSURANCE COMPANY OF THE WEST Policy Number: WSD5034539
I certify that in the performance of,the work for which this permit is issued, I
shall not employ any person'in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section ' -.700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this appl"cation is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and.
employees for any act or omission related to tie work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to tante lation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordi -iances and state laws relating to building
construction, and hereby authorize representaives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicantor Agent)..1����
Date: 3/27/2017
Application Number: BMCH2017-0092
Owner:
Property Address: 48243 CALLE FLORISTAS
JOHN KOSINSKI
APN: 646092022
48243 CALLEFLOMSTAS
Application Description: GONZALES / HVAC CHANGE OUT 16 SEER
LA QUINTA, CA 92 253
Property Zoning:
Application Valuation: $8,000.00
Applicant:
Contractor:
IE INC `
VOTTA ENTERPRISES INC DBA COMFORT AIR
31225 LA BAYA
72248 NORTHSHORE ST STE 101
WESTLAKE VILLAGE, CA 91362
THOUSAND PALMS, CA 92276
(760)320-5800
-------------------------------------------------------------------------------------------
Llc. No.: 763937
Detail: HVAC CHANGE OUT - 16 SEER/80AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
_QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY IF
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
1 0
1 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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L: Q,dna, CA 92253 •f760) 777-70 12
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Project type (code otte): Ncw Add'n AiLer
Sq. Ft: 0 Stories:
Repair Demo .
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Name of Conw Pason:
Telephone i of Cor d Fiasco:
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F.s�od• Vatic of Project
APPLICANT: 00 NOT WRITE BELOW THIS 11NE
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CERTIFICATE OF COMPLIANCE .
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC)
Project Name:
JOHN KOSINSKI I Date Prepared:
CFIR-ALT-02-E
(Page 1 of 3)
2017-03-25
A. General Information
CF111-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one
MR -ALT -02 docuirent for each dwelling unit.
01
Project Name
JOHN KOSINSKI
02
Date Prepared
2017-03-25 ,
03
Project Location
48243 CALLE FLORISTA
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
JOHN KOSINSKI
:4,801
.
Dwelling Unit Conditioned
07
Zip Code
92253A
08
Floor Area (ft2)
1852
SC System
SC System
CFA served
Number of Space
refrigerant
09
Climate Zone
15
10
Conditioning (SC) Systems in
1
Location or Area
by this SC
ducted
containing
this Dwelling Unit:
more than 40
" "X, '.'
B. Space Conditioning (SC) System Information f ^
02
03
04
0
y#
4o; 't-,
`69
10
*k d
-N
:4,801
.
Ni the SCS
Installing a
Z«O * 7
X4:«7 + d
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft)
system?
component?
components?
feet of ducts?
duct system?
'SC system?
Alteration Type
System 1
Location 1
1852
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (SectionIS0.2(b)iDiib)
This section does not apply to this project.
Registration Number: 217-A020095187A-000-000-0000000-0000
CA Building Enerav Efficiencv Standards - 2016 Residential Compliance
Registration Date/Time:
Report Version: 2016.1.005
2017-03-25 16:00:49
HERS Provider: CalCERTS
Report Generated: 2017-03-25 16:00:44
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -111 -ALT -HVAC) (Page 2 of 3)
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
01
02
03
04
0S
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Central gas
All new
Central split
All new
This field or
This field or
System 1
furnace
heating
AFUE
80
AC
cooling
SEER
16
Setback
section is not
section is not
components
components
applicable
applicable
Reouired Documentation:
CF211-MCH-03-E - Space Conditioning Systems
- Duct Insulation requirement for the new portions of supply air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H -Duct Leakage Test required wheni:heating or cooling components are Installed in ducted systems, or when more than 40 ft of duct length is replaced
-Leakage rate compliance: <= 15% or <=10% leakage to outside.or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification eequired when refrigerant containing components are installed or altered (applicable In CZ 2, 8-15).
CF211 and CF311-MCH-23 Airflow Rate >= 300;Cf,1M.'p,erA wrequired;whensMCH-25 Is required.
Exceotions:
Duct systems registered with HERS provider a's previously sealed are exempt from MCH -20 Duct Leakage Testing.requirements r
Heating -only systems and Air Handler Furnace do Gerificati n o Air Flow. MCH 23 - L f
Chafge M I1
changes not require -*or Refr�, gerant -1i
Existing duct systems constructed, insulated or sealed with asbestos�are exempt from MCH 20�bu kage Testingrequfument .
IF
.Le
;:. In 7914, 'tom ;-ft. ift rel rs. Wj II
E. Entirely New or Complete Replacement Du&Qhtem, with or withoutIquipment Changeout (Sections 150 2(b)1Diia and 150.2(b)1E, F)
t ;
This section does not apply to this project. M
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 217-A020095187A-000-000-0000000-0000
Registration Date/Time
2017-03-25 16:00:49
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-25 16:00:44
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3)
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation Is accurate and complete.
Documentation Author Name:
Documentation Author Signature: //'�
Jacoby, Ian
can dacobr
Company:
Signature Date:
i PERMIT E RATERS
2017-03-25 16:00:49
Address:
CEA/ HERS Certification Identification (if applicable):
31225 to Baya Drive #213
City/State/Zip:
Phone:
West Lake Village CA 91362
818-735-7876
Responsible Person's Declaration statement.;;..;
I certify the following under penalty of perjury, under thelawf'of the State of California:
1. The Information provided on this Certlficate<of Compliance.js true and correct.
2. 1 am eligible under Division 3 of the Busines3 and Professions Code to accept.resporisiblilty for the building design or system design Identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications materials components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part i and Parf 6:;of the California Code of Regulations. , `ms's �
M. _:,�
4. The building design features or system design features identified on, Certificate of Compliance are consistent with the inform&n provided on'otherfapplicable'co"mpliance documents, worksheets,
AVL
calculations, plans and specifications submitted to tt a enforcement agency for a p val with.this building permitapplication .
5. 1 will ensure that a registered copy of this Certiflcaterof C mpllance shall made<available with the building permit(s):;lssueex d fon, building and pad_e available to the enforcement agency for all applicable
`R.rvr� ' .. vi
inspections.
I understand that a registered copy of this er,,locate of Complllance. s required to be,included with the�documentation..the builder provides to the building owner at occupancy.
Responsible Designer Name: %
Responsible Designer Sfgna4ure: .;+ �
Jacoby, Ian
�an �acobJr
Company:
Date Signed:
I PERMIT E RATERS
2017-03-25 16:00:49
Address:
License:
31225 La Baya Drive #213
City/State/Zip:
rnone:
West Lake Village CA 91362.
818-735-7876
Digitally signed by Ca/CERTS. This digital signature is provided in order to secure the content of this registered document and in no way implies Registration Provider
responsibility for the accuracy of the information.
Registration Number: 217-A020095187A-000-000-0000000-0000
Registration Date/Time:
2017-03-25 16:00:49
HERS Provider: CaiCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-25 16:00:44
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